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Finals > GU and Renal > Flashcards

GU and Renal Flashcards

1
Q

What is the epidemiology of renal stones (4)

A
  • 10-15% risk in lifetime
  • 50% re-occurrence rate
  • Most are calcium urate or calcium phosphate
  • More common in males, 20-40
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2
Q

What are the risk factors for renal stones (7)

A
  • Hypercalcaemia
  • Dehydration
  • Infection
  • Renal disease
  • Family history
  • Anatomical abnormalities
  • Gout
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3
Q

Describe the pathophysiology of renal stones

A
  • Stones formed in supersaturated urine
  • Most are calcium oxolate (60-65%), calcium phosphate (10%) or uric acid
  • Often can cause obstruction leading to hydronephrosis (blockage and dilatation of renal pelvis) which can lead to permanent damage
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4
Q

Where are the most common sites for renal stones to get stuck (3)

A
  • Pelvic brim
  • Pelvoureteric junction
  • Vesicoureteric junction
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5
Q

How might kidney stones present (4)

A
  • Renal colic
    • Sudden onset excruciating abdo pain
    • Patient writhing in pain, cannot lie still
    • Loin to groin in waves
    • Nausea and vomiting
  • Dysuria
  • Haematuria
  • Frequency
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6
Q

How would you diagnose renal stones (4)

A
  • Urine dipstick/midstream sample
  • KUB X-ray
  • Non-contrast CT KUB (gold standard/diagnostic)
  • Ultrasound
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7
Q

How would you treat renal stones (6)

A
  • Analgesia
  • Antibiotics if infection
  • Anti-emetics
  • Surgery
  • Lithotripsy
  • Medical expulsive therapy eg. Tamsulosin
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8
Q

Define acute kidney injury (AKI)

A
  • An abrupt sustained rise in serum Urea and Creatanine due to a rapid decline in GFR leading to inability to maintain acid base, fluid and electrolyte homeostasis
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9
Q

What is the criteria for AKI (3)

A
  • Rise in serum Cr >26umol/L in 48 hours
  • Rise in serum Cr >1.5x baseline
  • Urine output <0.5ml/kg/hour for 6+ hours
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10
Q

What is the epidemiology of AKI (2)

A
  • Common (occurs in 18% of hospital patients)

- Common in the elderly

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11
Q

What are the 3 causes of AKI

A
  • Pre-renal
  • Intra-renal
  • Post-renal
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12
Q

What are pre-renal causes of AKI (3)

A
  • Hypoperfusion
    • Hypotension/hypovolaemia
    • Dec. cardiac output
    • Shock
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13
Q

What are Intra-renal causes of AKI (4)

A
  • Nephrotoxic drugs
  • Vasculitis
  • Acute tubular necrosis
  • Glomerulonephritis
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14
Q

What are post-renal causes of AKI (3)

A
  • Blockage
    • Tumour
    • Stone
    • BPH
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15
Q

What are the risk factors for AKI (6)

A
  • Age >75
  • Heart failure
  • CKD/glomerulonephritis
  • Diabetes
  • Nephrotoxic drugs
  • Prostate cancer/BPH
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16
Q

How might AKI present (4)

A
  • Depends on cause
  • Oliguria
  • Oedema
  • Thirst
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17
Q

How would you diagnose AKI (2)

A
  • Using criteria

- Find underlying cause (biopsy, scans etc.)

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18
Q

What is the treatment for AKI

A
  • Treat underlying cause
  • Stop nephrotoxic drugs
  • Dialysis (hamofiltration/haemodialysis)
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19
Q

How can glomerulonephritis present (4)

A
  • Acute nephritic syndrome
  • Nephrotic syndrome
  • Asymptomatic urine abnormalities
  • Chronic kidney disease
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20
Q

What is acute nephritic syndrome characterised by (4)

A
  • Haematuria
  • Proteinuria
  • Oedema
  • Hypertension
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21
Q

What are the causes of acute nephritic syndrome (4)

A
  • IgA nephropathy (most common)
  • Infection/post infection
  • SLE
  • Systemic sclerosis
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22
Q

How might acute nephritic syndrome present (6)

A
  • Haematuria
  • Proteinuria
  • Oedema
  • Hypertension
  • Oliguria
  • Decreasing kidney function
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23
Q

How do you diagnose acute nephritic syndrome (3)

A
  • Mid stream urine/dipstick
  • Renal biopsy
  • Bloods (Raised Cr, Urea, Low albumin and eGFR)
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24
Q

How do you treat acute nephritic syndrome (2)

A
  • Treat cause

- Hypertension (CCB/diuretics)

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25
Q

What are the characteristics of nephrotic syndrome (4)

A
  • Proteinuria
  • Hypoalbuminaemia
  • Hyperlipidaemia
  • Oedema
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26
Q

What can cause nephrotic syndrome (2)

A
  • Associated with podocyte damage
    • Minimal change disease (primary)
    • Diabetes (secondary)
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27
Q

How might nephrotic syndrome present (3)

A
  • Proteinuria (frothy urine)
  • Oedema
  • May be hypertension
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28
Q

How do you diagnose nephrotic syndrome (3)

A
  • Urine dipstick (proteinuria)
  • Bloods (hypoalbuminaemia, may be raised Cr/urea)
  • Renal biopsy
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29
Q

How do you treat nephrotic syndrome (4)

A
  • Diuretics (oedema)
  • B.P control (proteinuria) (ACE-i)
  • Simvastatin (hyperlipidaemia)
  • Warfarin (low albumin can cause thrombosis)
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30
Q

What is chronic kidney disease (CKD) (2)

A
  • A longstanding, usually progressive impairment of renal function for 3 months+
  • Defined as GFR <60ml/min/1.73m2 for more than 3 months
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31
Q

What is the epidemiology of CKD (2)

A
  • More common in females

- Inc. with age

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32
Q

What can cause CKD (9)

A
  • Diabetes
  • AKI
  • SLE
  • Idiopathic
  • PKD
  • Atherosclerosis
  • Family history
  • Malignancy
  • Hypercalcaemia
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33
Q

Describe the pathophysiology of CKD

A
  • Progressive scarring of nephrons leads to their failure
  • This means that the flow of blood is re-directed to other nephrons
  • This causes and increased flow and stress on the nephrons accelerating their scarring and failure
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34
Q

How might CKD present (7)

A
  • Early stages are asymptomatic (kidney has large reserve volume
  • Malaise
  • Weight loss/anorexia
  • Polyuria/nocturia
  • Oedema
  • Nausea/vomiting/diarrhoea
  • Itching
  • Amenorrhea/E.D
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35
Q

How would you diagnose CKD (4)

A
  • Urine sample
  • Renal biopsy
  • Ultrasound (small kidneys)
  • Bloods (raised Cr and Urea, Low eGFR and Ca)
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36
Q

How do you treat CKD (5)

A
  • Control progression/complications
    • B.P control
    • Biphosphonates/Calcitriol (low calcium)
    • Simvastatin and warfarin (CVD)
    • Duiretics (oedema)
  • RRT
  • Transplant
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37
Q

What are the indications for dialysis in CKD/AKI (4)

A
  • Hyperkalaemia
  • Symptomatic uricaemia
  • Pulmonary oedema
  • Acidosis
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38
Q

What are the 3 types of Renal replacement therapy (RRT)

A
  • Haemofiltration
  • Haemodialysis
  • Peritoneal dialysis
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39
Q

Describe Haemofiltration

A
  • Blood drawn through double lumen catheter by pump and replacement solution is infused in.
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40
Q

Describe Haemodialysis

A
  • Blood drawn out through A.V fistula passed over semi-permeable membrane with solution passing other way allowing solutes to move down conc. gradient
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41
Q

Describe Peritoneal dialysis

A
  • Peritoneum used a membrane for solute exchange with blood
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42
Q

What are the potential complications of RRT (3)

A
  • Hypertension (stroke/MI)
  • Malignancy
  • Infection
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43
Q

Describe the epidemiology of autosomal dominant polycystic kidney disease (ADPKD) (3)

A
  • Most common inherited kidney disease
  • More common in males
  • Presents in early adulthood
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44
Q

What mutations occur in ADPKD and ARPKD (3)

A
  • PKD 1 on chromosome 16
  • PKD 2 on chromosome 4
  • PKHD 1 on chromosome 6 (ARPKD)
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45
Q

Describe the pathophysiology of PKD

A
  • Cysts cause mechanical pressure and reactive fibrosis leading to progressive renal failure
  • The rate of renal decline depends on the size and growth rate of cysts
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46
Q

How might PKD present (5)

A
  • Haematuria
  • Loin pain
  • Palpable enlarged kidney
  • Nocturia
  • Stones
47
Q

How would you diagnose (AD/AR) PKD (2)

A
  • Ultrasound
    • Enlarged cystic kidneys
    • 15-39 (3)
    • 40-59 (2 on each)
    • 60+ (4 on each)
  • Family history/genetic testing
48
Q

How do you treat PKD (4)

A
  • B.P control
  • Laproscopic removal/nephrectomy
  • Family screening
  • RRT for ESRF
49
Q

How do you tell different diseases by testicular palpitation (5)

A
  • Can’t get above it = Hernia or hydrocele
  • Separate and cystic = epididymal cyst
  • Separate and hard = varicocele
  • Testicular and cystic = hydrocele
  • Testicular and hard = tumour
50
Q

What is the epidemiology of epididymal cyst (3)

A
  • Cyst containing milky fluid
  • Not uncommon
  • Most common about 40
51
Q

How might epididymal cysts present (4)

A
  • Usually have noticed a lump
  • May be multiple and bilateral
  • Symptomatic if large
  • Palpable separate from testis and cystic
52
Q

How do you diagnose and treat epididymal cysts

A
  • Testicular ultrasound

- Surgery if symptomatic

53
Q

What is the Epidemiology of hydrocele (2)

A
  • Abnormal collection of fluid in tunica vaginalis

- Can be primary or secondary

54
Q

How might hydrocele present (2)

A
  • Non tender, smooth swelling of testicles

- Only painful if infected

55
Q

How do you diagnose/treat hydrocele

A
  • Testicular ultrasound

- Needle aspiration or surgery if symptomatic

56
Q

What is the epidemiology of varicocele (3)

A
  • Abnormal swelling of testicular veins due to venous reflux
  • Incidence increases after puberty
  • More common on the left side
57
Q

How might varicocele present (3)

A
  • ‘Bag of worms’
  • Hard and separate
  • Dull ache and heavy scrotum
58
Q

How do you diagnose/treat varicocele

A
  • Venography

- Surgery is symptomatic

59
Q

What is the epidemiology of testicular torsion (2)

A
  • Twisting (torsion) of spermatic cord leading to vessel occlusion and hence ischaemia and infarct
  • Left side is more commonly affected
60
Q

How might testicular torsion present (4)

A
  • Sudden onset severe testicular pain
  • Abdominal pain
  • Nausea and vomiting
  • Very hot, swollen, tender testicle
61
Q

How do you diagnose testicular torsion

A
  • DO NOT DELAY SURGERY

- Doppler ultrasound

62
Q

What is the treatment for testicular torsion

A
  • Rapid surgery (6 hours to save testicle)

- Orchidectomy

63
Q

What are the storage LUTS (4)

A
  • Overflow incontinence
  • Urgency
  • Frequency
  • Nocturia
64
Q

What are the voiding LUTS (7)

A
  • Haematuria
  • Dysuria
  • Hesitancy
  • Poor stream
  • Post micturition dribbling
  • Poor emptying
  • Straining
65
Q

What is acute urinary retention and how might it present

A
  • A painful inability to pass urine, usually with over 500ml urine in the bladder
  • Cannot pass urine, painful/tender palpable bladder
66
Q

What can cause acute urinary retention (6)

A
  • LUT obstruction (stones/tumour)
  • BPH/Prostate cancer
  • Cauda equina syndrome
  • Alcohol
  • Post op
  • Infection
67
Q

How do you treat acute urinary retention (4)

A
  • Catheterise
  • Tamsulosin (alpha 1 blocker)
  • Finasteride (5 alpha reductase inhhibitor)
  • Treat underlying cause
68
Q

What is the epidemiology of benign prostate hyperplasia (BPH) (3)

A
  • Inc. with age
  • Common (40% of over 60)
  • Afro-Caribbeans more affected
69
Q

How might BPH present

A
  • Nocturia (most common)

- Typical LUTS

70
Q

How do you diagnose BPH (4)

A
  • DRE (smooth, enlarged prostate)
  • Serum PSA raised
  • Ultrasound
  • Urine dipstick/midstream to exclude infection
71
Q

How do you treat BPH (3)

A
  • Alpha 1 antagonists (tamsulosin)
  • 5 alpha reductase inhibitors (finasteride)
  • Surgery (transurethral resection of prostate)
72
Q

What is the epidemiology of renal cell carcinoma (RCC) (3)

A
  • Most common renla tumour in adults
  • Rare under 40
  • More common in males
73
Q

What are the risk factors for RCC (6)

A
  • Smoking
  • Obesity
  • Hypertension
  • PKD
  • Von Hippel Lindau syndrome
  • Renal replacement therapy
74
Q

Describe the pathophysiology of RCC

A
  • Malignancy of the proximal convuluted tubule epithelium

- 25% metastases on presentation

75
Q

How might RCC present (5)

A
  • Haematuria
  • Loin/flank pain
  • Palpable mass
  • Anorexia, weight loss, malaise
  • Hypertension (some RCC secrete renin)
76
Q

How do you diagnose RCC (3)

A
  • Renal biopsy
  • Ultrasound
  • MRI (staging)
77
Q

How do you treat RCC (3)

A
  • Total/partial nephrectomy
  • Chemotherapy
  • Radiotherapy
78
Q

What is the epidemiology of transitional cell carcinoma (TCC) (3)

A
  • 50% bladder
  • 4th most common cancer in men, 8th in women
  • More common in older people
79
Q

What are the risk factors for TCC (6)

A
  • Male
  • Smoking
  • Rubber/chemical industry
  • Inc. age
  • Catheter
  • Family history
80
Q

How might TCC present (2)

A
  • Painless haematuria

- Voiding irritability

81
Q

How do you diagnose TCC (3)

A
  • Cystoscopy (diagnostic)
  • CT/MRI
  • Urine dipstick/mid-stream sample
82
Q

How do you treat TCC (4)

A
  • Resection of tumour
  • Radical cystectomy
  • Radical radiotherapy
  • Chemotherapy
83
Q

What is the epidemiology of prostate cancer (5)

A
  • 4th most common cancer in men
  • Increases with age
  • By 80, 80% of men have a malignancy, but most are inactive
  • Mostly adenocarcinoma in peripheral zone of prostate
  • More common in black people due to raised testosterone
84
Q

What are the risk factors for prostate cancer (4)

A
  • Increasing age
  • Black
  • Family history
  • Genetic
85
Q

How might prostate cancer present (3)

A
  • Nocturia
  • LUTS
  • Malaise, weight loss, anorexia
86
Q

How do you diagnose prostate cancer (3)

A
  • Trans-rectal ultrasound with biopsy
  • DRE (hard, irregular)
  • Serum PSA
87
Q

How do you treat prostate cancer (3)

A
  • Often just monitoring
  • Endocrine therapy
    • Androgen receptor blockers (bicalutamide)
  • Radiotherapy
88
Q

What is the epidemiology of testicular cancer (3)

A
  • Most common cancer in men aged 15-44
  • 10% occur in undescended testis
  • > 96% arise from germ cells
89
Q

What are the risk factors for testicular cancer (3)

A
  • Family history
  • Undescended testis
  • Infertility
90
Q

How might testicular cancer present (4)

A
  • Hard lump in testicle (may be painless)
  • Testicular (w/without abdominal) pain
  • Hydrocele
  • Weight loss/malaise
91
Q

How do you diagnose testicular cancer (3)

A
  • Testicular ultrasound
  • Biopsy
  • CT (staging)
92
Q

How do you treat testicular cancer (4)

A
  • Orchidectomy
  • Radiotherapy
  • Chemotherpay
  • Sperm storage
93
Q

Define UTI (2)

A
  • Inflammation of urothelium in response to bacterial colonisation
  • 10^5 organisms/ml in fresh mid-stream urine sample
94
Q

What 5 pathogens usually cause UTI

A
  • KEEPS
  • Klebsiella spp
  • E.coli (most common)
  • Enterococci
  • Proteus spp
  • Staphylococcus spp
95
Q

What is the epidemiology of pyelonephritis (2)

A
  • More common in women <35

- Associated with significant sepsis

96
Q

What are the risk factors for pyelonephritis (6)

A
  • Structural abnormality
  • Stones
  • Catheter
  • Pregnancy
  • Diabetes
  • Immunosupression
97
Q

How might pyelonephritis present (5)

A
  • TRIAD: loin pain, fever, pyuria
  • Severe headache
  • Oliguria
  • Rigors/malaise
  • Nausea and vomiting
98
Q

How do you diagnose pyelonephritis (2)

A
  • Urine dipstick

- Mid stream urine microscopy

99
Q

How do you treat pyelonephritis

A
  • Rest, water, cranberry juice
  • Analgesia
  • IV/oral co amoxiclav
100
Q

What are the risk factors for cystitis (4)

A
  • Catheter
  • Stones/obstruction
  • Previous bladder damage
  • Incomplete bladder emptying
101
Q

How might cystitis present (2)

A
  • LUTS

- Abdo./loin pain/tenderness

102
Q

How do you diagnose cystitis (2)

A
  • Urine dipstick

- Mid stream urine microscopy

103
Q

How do you treat cystitis

A
  • Trimethoprim

- Co amoxiclav if severe/non-responsive

104
Q

How might prostatitis present (4)

A
  • Voiding LUTS
  • Pelvic pain
  • Fever, rigors, malaise
  • Pain on ejaculation
105
Q

How do you diagnose prostatitis (4)

A
  • Mid-stream urine sample
  • Urine dipstick
  • DRE (warm, swollen and tender)
  • Trans-urethral ultrasound
106
Q

How do you treat prostatitis (2)

A
  • Acute
    • IV co amoxiclav and gentamicin
  • Chronic
    • Ciprafloxacin
107
Q

What is the epidemiology of urethritis (2)

A
  • Primarily caused by STI (chlamydia most common and gonorrhoea)
  • Most common urological condition in men
108
Q

How might urethritis present (4)

A
  • Dysuria +/- blood and pus
  • Urethral pain
  • Penile discomfort
  • Systemic symptoms
109
Q

How do you diagnose urethritis (2)

A
  • First void urine in men, vaginal swab in women (microscopy)
  • Urethral swab
110
Q

How do you treat Urethritis (2)

A
  • Chlamydia (azithromycin)

- Gonorrhoea (azithromycin and ceftriaxone)

111
Q

What is the aetiology of epididymo-orchitis (4)

A
  • <35 STI
  • > 35 UTI
  • Mumps
  • Catheter
112
Q

How might epididymo-orchitis present (3)

A
  • Unilateral swollen and painful testis
  • Sweats/fever
  • May be dysuria
113
Q

How do you diagnose Epididymo-orchitis (2)

A
  • First void urine microscopy

- Urethral swab/smear

114
Q

How do you treat epididymo-orchitis

A
  • Chlamydia (azithromycin)
  • Gonorrhoea (azithromycin and im ceftriaxone)
  • UTI (ciprofloxacin)

Finals (11 decks)

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